Pharmacists versus nonpharmacists in adverse drug event detection: a meta-analysis and systematic review.

Full Abstract

PURPOSE:
A systematic review and metaanalysis were conducted to determine if studies that included pharmacists as chart reviewers detected higher rates of adverse drug events (ADEs) than studies that included other health care professionals or hospital personnel as chart reviewers.

METHODS:
A systematic review and metaanalysis of studies using chart review as the method of detection of ADEs were conducted. Pooled estimates of the ADE rates were calculated using the inverse variance weight method. Meta-analysis was performed using a random effects model. Using the Mann-Whitney U test, weighted rates of studies in which pharmacists versus other clinicians were the chart reviewers were compared.

RESULTS:
Thirteen studies satisfied the inclusion criteria. Using random effects metaanalysis, the mean of the weighted incidence rate detected by pharmacists was 0.33 ADE per admission (95% confidence interval [CI], 0.17-0.50); the mean was 0.16 ADE per admission (95% CI, 0.11-0.22) with detection by nonpharmacists. Significant heterogeneity was present between studies in both groups. A significant difference (p=0.003) existed between the ADE rate reported by pharmacists (median=0.23; interquartile range [IQR], 0.18-0.44) and that of nonpharmacists (median=0.12; IQR, 0.02-0.49). Although there is overwhelming evidence of statistical heterogeneity, the numbers pertaining to the ADE rates detected by the two groups were large enough to indicate significant differences. Despite the heterogeneity, there is strong evidence that pharmacist-led interventions based on chart review report a higher ADE rate among inpatients.

CONCLUSION:
A review of the literature revealed that pharmacists make a salient contribution as manual chart reviewers in inpatient ADE interventions.

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Author information

Author/s: Phansalkar, Shobha (S); Hoffman, Jennifer M (JM); Nebeker, Jonathan R (JR); Hurdle, John F (JF);

Affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, and Department of Veterans Affairs Medical Center 84132, USA. shobha.phansalkar(-atsign-)hsc.utah.edu

Journal and publication information

Publication Type: Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review

Journal: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists (Am J Health Syst Pharm), published in United States. (Language: eng)

Reference: 2007-Apr; vol 64 (issue 8) : pp 842-9

Dates: Created 2007/04/10; Completed 2007/06/05;

PMID: 17420201, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adverse Drug Reaction Reporting Systems
Hospitals
Medical Audit - methods
Models, Statistical

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